Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.
BMC Surg. 2020 Nov 4;20(1):270. doi: 10.1186/s12893-020-00928-z.
This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE.
We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods.
A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05).
The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.
本研究旨在探讨先天性膈膨出（CDE）的临床特征，并比较胸腔镜和传统开胸手术治疗婴儿 CDE 的疗效。
我们回顾性分析了 10 年来我院收治的 125 例 CDE 患儿（90 例男性，35 例女性；中位年龄 12.2 个月，范围 1 h-7 岁；体重 1.99-28.5 kg，中位数 7.87±4.40 kg）的临床资料，并对其临床表现和手术方法进行了统计学分析。
本组 108 例患儿均行手术治疗，其中 67 例行开胸手术，41 例行胸腔镜膈神经折叠术。术后除 1 例患儿因术后呼吸困难死亡外，其余 107 例患儿均恢复良好。术后 1-9.5 年随访，107 例患儿术前症状明显改善。随访期间，膈位置正常，未见反常呼吸运动。17 例未行手术治疗的患儿中，11 例在 1-6 年后膈位无下降。胸腔镜组手术时间、术中出血量、胸腔引流时间、术后机械通气时间、术后住院时间及术后 CCU 入住时间等指标均优于开胸组，差异有统计学意义（P<0.05）。
先天性膈膨出的临床症状轻重不一。症状严重者应行手术治疗。胸腔镜膈神经折叠术和传统开胸手术均可有效治疗先天性膈膨出，但与开胸手术相比，胸腔镜膈神经折叠术具有手术时间短、创伤小、恢复快等优点。因此，胸腔镜膈神经折叠术应作为先天性膈膨出患儿的首选治疗方法。
